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Thrombolytics in pulmonary embolism

Sam Schulman
During the past 7 years, results from phase III trials comparing nonvitamin antagonist K oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) or with placebo, including 34,900 patients, have been published. Recent guidelines have been updated and now suggest treatment with NOACs rather than with VKA. Other updates in the guidelines concern the initial thrombolytic treatment for selected patients with deep vein thrombosis or pulmonary embolism as well as the possibility of withholding anticoagulation for minimal venous thromboembolism...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Debabrata Bandyopadhyay, Tanmay S Panchabhai, Navkaranbir S Bajaj, Pradnya D Patil, Matthew C Bunte
BACKGROUND: Primary pulmonary artery sarcoma (PPAS) is a rare tumor that mimics pulmonary thromboembolism (PE). Similarities to PE can delay the diagnosis and misguide the treatment of PPAS. This study aimed to evaluate tumor characteristics and outcome predictors among those diagnosed with PPAS and misdiagnosed as PE. METHODS: From 1991-2010, 10 PPAS cases were available from the Cleveland Clinic (CC) institutional database and another 381 cases were reported in the literature...
September 2016: Journal of Thoracic Disease
Timothy J Fuller, Christopher M Paprzycki, Muhammad H Zubair, Lala R Hussain, Brian A Kuhn, Matthew H Recht, Patrick E Muck
BACKGROUND: Interventional strategies for massive and submassive Pulmonary Embolism (smPE) have historically included either systematic intravenous thrombolytic alteplase (IV TPA) or surgical embolectomy, both of which are associated with significant morbidity and mortality. However, with the advent of endovascular techniques, recent studies have suggested that an endovascular approach to the treatment of acute smPE may be both safe and effective with excellent outcomes. The purpose of this study was to evaluate the outcomes of patients who have undergone catheter directed thrombolysis (CDT) for smPE at our institution in an effort to determine the safety of the procedure...
September 22, 2016: Annals of Vascular Surgery
Md Shahidul Islam
Clinicians need to make decisions about the use of thrombolytic (fibrinolytic) therapy for pulmonary embolism (PE) after carefully considering the risks of major complications from bleeding, and the benefits of treatment, for each individual patient. They should probably not use systemic thrombolysis for PE patients with normal blood pressure. Treatment by human recombinant tissue plasminogen activator (rt-PA), alteplase, saves the lives of high-risk PE patients, that is, those with hypotension or in shock...
September 15, 2016: Advances in Experimental Medicine and Biology
Ziv Beckerman, Gil Bolotin
Massive pulmonary embolism (MPE) is a life-threatening condition. The management of MPE has changed over the course of the last few years. Since the emergence of thrombolytic therapy, only a few patients remain amenable for surgical treatment. Currently, surgical embolectomy is advised only in very specific indications. This chapter will review the background, history, indications, surgical technique and results of surgical pulmonary embolectomy in patients with MPE.
September 13, 2016: Advances in Experimental Medicine and Biology
Aaron Samuel Weinberg, Suhail Dohad, Danny Ramzy, Hooman Madyoon, Victor F Tapson
Clinical guidelines support the use of systemic thrombolytic therapy for acute massive pulmonary embolism (PE). When anticoagulation and thrombolysis fail or are contraindicated, options become limited. We report an acute PE case in which treatment options were limited, and a novel device, the FlowTriever (Inari Medical, Irvine, California), was successfully used. This is the first case report of the use of this device that we are aware of.
September 6, 2016: Journal of Intensive Care Medicine
Hem Desai, Bhupinder Natt, Christian Bime, Joshua Dill, James E Dalen, Joseph S Alpert
BACKGROUND: Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality...
August 24, 2016: American Journal of Medicine
Chou-Chin Lan, Chung-Kan Peng, Shih-En Tang, Shu-Yu Wu, Kun-Lun Huang, Chin-Pyng Wu
Ischemia-reperfusion (IR)-induced acute lung injury (ALI) is implicated in several clinical conditions like lung transplantation, acute pulmonary embolism after thrombolytic therapy, re-expansion of collapsed lung from pneumothorax or pleural effusion, cardiopulmonary bypass and etc. Because mortality remains high despite advanced medical care, prevention and treatment are important clinical issues for IR-induced ALI. Vascular endothelial growth factor (VEGF) has a controversial role in ALI. We therefore conducted this study to determine the effects of anti-VEGF antibody in IR-induced ALI...
2016: PloS One
Qaiser Shafiq, George V Moukarbel, Rajesh Gupta, Dawn-Alita Hernandez, Samer J Khouri
Acute pulmonary embolism remains a common cause of mortality. Early diagnosis and appropriate risk stratification is necessary to individualize treatment strategy. Computed tomography scan of the pulmonary arteries is routinely used to diagnose acute pulmonary embolism and in some cases is useful to assess right ventricular dilation. In patients with acute pulmonary embolism, right ventricular dilation and dysfunction indicates a high-risk situation where immediate administration of thrombolytic agent, catheter-directed thrombolysis, or surgical embolectomy could be considered...
August 10, 2016: Journal of Echocardiography
Mohsen Sharifi, Jeremy Berger, Paul Beeston, Curt Bay, Zoltan Vajo, Seyed Javadpoor
OBJECTIVE: Pulseless electrical activity (PEA) during cardiac arrest portends a poor prognosis. There is a paucity of data in the use of thrombolytic therapy in PEA and cardiopulmonary arrest due to confirmed pulmonary embolism (PE). We evaluated the outcome of low-dose systemic thrombolysis with tissue plasminogen activator (tPA) in patients presenting with PEA due to PE. METHODS: During a 34-month period, we treated 23 patients with PEA and cardiopulmonary arrest due to confirmed massive PE...
June 30, 2016: American Journal of Emergency Medicine
Xiangchen Meng, Yong Lv, Bojing Zhang, Chuangye He, Wengang Guo, Bohan Luo, Zhanxin Yin, Daiming Fan, Guohong Han
PURPOSE: To evaluate safety and efficacy of balloon dilation and stent placement combined with thrombus aspiration and thrombolysis to treat patients with Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS: Charts from 55 consecutive patients with primary BCS and IVC thrombosis treated between April 2000 and August 2014 were retrospectively analyzed. Transcatheter aspiration and percutaneous recanalization were attempted in all patients, and stents were placed if balloon dilation was successful...
October 2016: Journal of Vascular and Interventional Radiology: JVIR
Simon De Freitas, Caoilfhionn Connolly
INTRODUCTION: Unsuccessful thrombolysis in the setting of massive pulmonary embolism confers poor prognosis and the optimal management strategy is unknown. Options include re-thrombolysis and embolectomy. PRESENTATION OF CASE: A 32-year-old lady presented with massive pulmonary embolism accompanied by an intermittently-obstructive right atrial thrombus. Failure to improve with thrombolytic therapy prompted transfer to our cardiothoracic unit for emergency surgical embolectomy...
2016: International Journal of Surgery Case Reports
Faisal Shamim, Muhammad Rizwan, Adil Aziz
A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit...
June 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Eiji Yamada, Takashi Yoshioka, Masahiko Muro
We report a case of venous thromboembolism during the cisplatin-based adjuvant chemotherapy. A 49-year-old woman who was undergone left lower lobectomy for the lung cancer received adjuvant chemotherapy of cisplatin + vinorelbine ditartrate regimen. On day 11 after starting the chemotherapy, she presented a left lower leg pain and readmitted. Computed tomography revealed a deep venous thrombosis of the left lower leg and peripheral pulmonary embolism. The symptom and thromboembolism were successfully treated by anticoagulant drug and thrombolytic therapy...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Sara Verscheure, Paul B Massion, Franck Verschuren, Pierre Damas, Sheldon Magder
Dead space is an important component of ventilation-perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available technique called volumetric capnography (Vcap) allows measurement of physiological and alveolar dead space on a regular basis at the bedside...
June 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
Younes Nozari, Masih Tajdini, Mehdi Mehrani, Rosa Ghaderpanah
Distinguishing ST-elevation myocardial infarction (STEMI) differential diagnoses is more challenging. Myopericarditis is one of these differentials that results from viral involvement of myocardium and pericardium of the heart. Myopericarditis in focal form can mimic acute STEMI in its electrocardiogram (ECG) features and elevated cardiac enzymes. Myocarditis patients may face thrombolytic related complications such as intracranial bleeding, myocardial rupture, and hemorrhagic cardiac tamponade. Furthermore, re-administration of streptokinase (a common thrombolytic agent in our country) is banned for at least six months of previous administration; however, it can save patients' lives in emergency conditions such as massive pulmonary embolism...
2016: Emergency (Tehran, Iran)
Marija Vavlukis, Irina Kotlar, Emilija Chaparoska, Bekim Pocesta, Hristo Pejkov, Marjan Boshev, Sasko Kedev
AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis. CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since...
December 15, 2015: Open Access Maced J Med Sci
Vinod Namana, Sabah Siddiqui, Ram Balasubramanian, Rajeswer Sarasam, Vijay Shetty
Current mainstay treatment for pulmonary embolism (PE) includes oral anticoagulation, thrombolytic therapy, catheter embolectomy and acute surgical embolectomy. Surgical embolectomy is reserved for hemodynamically unstable patients (cardiogenic shock, cardiac arrest) and contraindication to thrombolytic therapy. We report a case of saddle PE in a young female with echocardiographic signs of right ventricular (RV) dysfunction who underwent early acute surgical embolectomy with a positive outcome. It would be beneficial to use bedside echocardiography even in hemodynamically stable patients to determine RV strain as this could act as an early indicator suggesting the escalation of therapy...
January 2016: Oxford Medical Case Reports
Alisa S Wolberg, Frits R Rosendaal, Jeffrey I Weitz, Iqbal H Jaffer, Giancarlo Agnelli, Trevor Baglin, Nigel Mackman
Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism. VTE is the leading cause of lost disability-adjusted life years and the third leading cause of cardiovascular death in the world. DVT leads to post-thrombotic syndrome, whereas pulmonary embolism can cause chronic pulmonary hypertension, both of which reduce quality of life. Genetic and acquired risk factors for thrombosis include non-O blood groups, factor V Leiden mutation, oral contraceptive use, hormone replacement therapy, advanced age, surgery, hospitalization and long-haul travel...
2015: Nature Reviews. Disease Primers
Hinesh Upadhyay, Khalid Sherani, Abhay Vakil, Mohammed Babury
Klippel - Trenaunay - Weber syndrome (KTWS) is a congenital condition characterized by a triad of capillary malformations of the skin, soft tissue and bone hypertrophy resulting in limb enlargement, and abnormalities of arteriovenous and lymphatic systems of the affected limb. In this case, we present a patient with KTWS receiving chronic anticoagulation that had a massive pulmonary embolism and was successfully treated with thrombolytic therapy. The purpose of this case is to educate readers about this uncommon condition and to increase awareness, recognition and timely treatment of its most common complications, namely thrombosis and pulmonary embolism...
2016: Respiratory Medicine Case Reports
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